tbuckley/cabot-search huggingface dataset:
P80 Real-world evidence of the effectiveness of secukinumab in patients with psoriasis with and without scalp involvement from the British Association of Dermatologists Biologics and Immunomodulators Register
Authors: Laura Savage, Jenny Hughes, Kia Matthews, Laura Rhodes
Journal: British Journal of Dermatology (2023)

Abstract Secukinumab is a fully human anti-interleukin-17A monoclonal antibody approved for the treatment of moderate-to-severe plaque psoriasis in adults, adolescents and children aged ≥ 6 years. The British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) is an ongoing prospective observational registry that collects long-term data from patients receiving biologics for psoriasis in the UK and the Republic of Ireland. We report the clinical effectiveness, drug survival and patient-reported outcomes of secukinumab treatment in patients from BADBIR with psoriasis with and without scalp involvement. Patients aged ≥ 18 years who had one or more follow-up visit(s) after enrolment in BADBIR and were receiving secukinumab according to label (300 mg weekly loading dose for 5 weeks, followed by monthly dosing) were included (data cutoff 31 August 2021). Baseline Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores recorded between 4 and 8 months and 10 and 14 months of secukinumab initiation were used as 6- and 12-month time points, respectively. Overall mean drug survival was calculated at 12, 24 and 36 months for patients with and without scalp involvement. Outcomes of interest were the proportion of patients with PASI scores of ≤ 2 and DLQI scores of 0/1. Drug survival up to 36 months (Kaplan–Meier method) was defined as the duration between the date of first exposure to secukinumab and date of stopping secukinumab or the end of the study censoring period. The analysis included 1298 patients with psoriasis with scalp (n = 883; 68.0%) and without scalp (n = 415; 32.0%) involvement. The mean duration of follow-up was 2.9 and 2.8 years in patients with and without scalp involvement, respectively. The majority were male (60.4% and 61.5%), mean age was 45.9 and 49.5 years, mean age at disease onset was 24.7 and 26.8 years, mean baseline PASI scores were 15.2 and 14.5, and mean baseline DLQI scores were 17.4 and 17.0 in patients with and without scalp involvement, respectively. Overall, the drug survival rates at 12, 24 and 36 months were 86%, 73% and 63% and 86%, 77% and 69% in patients with psoriasis with and without scalp involvement, respectively. At 6 and 12 months of treatment, 73.9% and 70.4% and 72.1% and 68.4% of patients with and without scalp involvement, respectively, achieved PASI scores ≤ 2. At 6 and 12 months of treatment, 56.9% and 59.2% and 52.0% and 55.4% of patients with and without scalp involvement, respectively, achieved DLQI scores of 0/1. This analysis of real-world data from BADBIR shows that treatment with secukinumab resulted in high drug survival and sustained and consistent improvements in PASI and DLQI in most patients with psoriasis with and without scalp involvement.
CD05 Return of cement-related allergic contact dermatitis: a case series and review of the literature
Authors: Sanaa Butt, Donna Thompson
Journal: British Journal of Dermatology (2023)

Abstract We report a case of a 23-year-old male bricklayer of 6 years who presented to our cutaneous allergy service with a 3-year history of a hand and foot dermatitis. Workwear included leather work boots and fibreglass gloves, which he used intermittently. His past medical history included childhood eczema and hay fever. Patch testing revealed strong reactions (++) to potassium dichromate and cobalt. Both were felt to be of current relevance due to cement exposure at work and from the leather in his boots. A review of our database revealed 8088 patients tested to the British Society for Cutaneous Allergy standard battery. A total of 662 were positive to cobalt and 339 to potassium dichromate. Of these, 121 patients were positive to both potassium dichromate and cobalt. Four of these were bricklayers, only one of whom was seen prior to the European Union (EU) cement directive. All reported hand dermatitis, and two also had foot involvement. In order to minimize chromate allergy, EU legislation in 2005 banned the sale of cements containing more than 2 parts per million (0.0002%) of hexavalent chromium. This minimal level is often achieved by adding a reducing agent such as ferrous sulphate to chromium III, which is less bioavailable and less likely to penetrate through the skin. Work suggests that rates of chromium-related allergic contact dermatitis (ACD) have diminished following this legislation with the incidence rate ratio between 2002–2004 and 2005–2009 falling to 0.37 (P = 0.001) in cement workers (Stocks SJ, McNamee R, Turner S et al. Has European Union legislation to reduce exposure to chromate in cement been effective in reducing the incidence of allergic contact dermatitis attributed to chromate in the UK? Occup Environ Med 2012; 69:150–2). Despite this change, sensitization is still possible without adequate protection, such as in our patient’s case. Additionally, the reducing agent’s activity diminishes over time; therefore, if it is not appropriately stored or used after its recommended shelf life, it may expose users to higher levels than are regulated. Despite the low concentration of cobalt in cement (0.01%), allergy may occur. It has been noted that sensitization to both metals is common in bricklayers, but this coexisting sensitivity was not seen in other professions where patients were allergic to chromium (Giménez Camarasa JM. Cobalt contact dermatitis. Acta Derm Venereol 1967; 47:287–92). We aim to highlight the ongoing issue of ACD associated with cement and review the recent history around potassium dichromate and cobalt in this regard.
P82 Validation of the dermatology life quality index (DLQI): a systematic review of the literature
Authors: Jeffrey Johns, Jui Vyas, Faraz Ali, John Ingram, Sam Salek, Ravinder Singh, Andrew Finlay
Journal: British Journal of Dermatology (2023)

Abstract The Dermatology Life Quality Index (DLQI) was first published in 1994, and, since that time, it has become the most widely used patient-reported outcome measure worldwide in dermatological studies, owing to its robustness, simplicity and ease of use. This study is the first to review systematically evidence of DLQI validation. MEDLINE, Cochrane Library, Embase, Web of Science, SCOPUS, CINAHL (EBSCO) and PsycINFO were searched for relevant peer-reviewed publications in English, combined into EndNote and filtered for inclusion and exclusion criteria. The study followed PRISMA guidelines, and the study protocol was prospectively published in PROSPERO. A bespoke REDCap database was created, and data from included studies were independently extracted into this by two reviewers. COSMIN guidelines were used to determine bias in studies, and only those studies that reported COSMIN-accepted methods of validation were included. A total of 1262 articles were found from online searches; on screening, 69 met the eligibility criteria, describing 19 216 patients. Studies were conducted in at least 26 different countries, with 13 in the USA, 8 in China, and 5 each in the UK, Brazil and Hungary. Most patients were recruited in hospitals (30.4%), clinics (21.7%) and outpatient departments (10.1%), and 22.5% in other settings; 13.0% was not specified. Twenty-nine studies were multicentred. Most studies (n = 38) collected data specifically for validation, five used data from randomized controlled trials, seven were case–control studies and one was an open-label study. One study was validation of a translation, and five were of cross-cultural adaptation. Psoriasis was the most common disease studied (n = 19; 27%), along with 19 other diseases. The UK English version of the DLQI was used in 18 studies, and 20 other language versions were also used in the other studies. Factor analysis was done in 21 studies, Rasch/item response theory (n = 5), test–retest (n = 14), Cronbach’s alpha (n = 33), known group (n = 19), convergent (n = 10), concurrent (n = 3), divergent (n = 2), content (n = 7), criterion (n = 2) and face (n = 2) validation and responsiveness (n = 15). COSMIN risk of bias showed that few studies met the current rigorous requirements of the guidelines. Extensive evidence of validation of the DLQI is provided to inform researchers’ decisions concerning its use. Recommendations for improving the research methodology and reporting of DLQI validation are also given.
P100 Dermoscopy and clinicohistopathological profile of lichen planopilaris restricted to the face: a case series of six unusual cases
Authors: Rohit Kothari, Sunmeet Sandhu
Journal: British Journal of Dermatology (2023)

Abstract Lichen planopilaris (LPP) is an autoimmune cicatricial alopecia that usually affects the scalp. LPP confined to the face is rare and the information on its dermoscopy is limited. We present the dermoscopy and clinicohistopathological profile of six patients, all but one of whom were men aged 32–60 years. A 12-year-old girl was the youngest patient in our series, as well as in the literature to the best of our knowledge. All patients presented with varying degrees of hyperpigmented atrophic patches and scarring alopecia restricted to the face. Two had a linear morphology, which is usually the most common presentation of facial LPP. In our series, the chin was the most frequently affected site, followed by the cheek and upper lips; the forehead was the least frequently involved. None of the patients had lesions elsewhere on the body, including the scalp. The duration of the lesions ranged from 1 to 6 months. All cases showed a brown-to-violaceous background and/or mild blotchy erythema, significantly reduced hair follicles, cicatricial alopecia and variable scaling and/or peripilar cast, brown dots, pigment pseudonetwork, pigment clumps and whitish scar-like areas on dermoscopy. Histopathology predominantly showed perifollicular inflammatory infiltrate, basal layer vacuolar degeneration and pigment incontinence, focal areas of perifollicular fibrosis corresponding to the erythema and peripilar cast, brown dots and pigment clumps, and scar-like areas. The men all described regular shaving, almost daily. The girl and two men described having a regular mustard oil massage over the face, which might have irritated and damaged the facial skin. The possibility of continuous microtrauma due to shaving and mustard oil application acting as a trigger leading to development of facial LPP cannot be ruled out. All patients received hydroxychloroquine, potent topical corticosteroids, intralesional steroids and/or oral steroids. Patient 3 was lost to follow-up; the rest are under regular follow-up with a favourable—albeit suboptimal—response. This case series highlights a rare presentation of LPP restricted to the face, with only a few similar cases with dermoscopy reported in the literature. Its diagnosis requires a high degree of suspicion in any case presenting with scarring alopecia and atrophic patches over the face. The treatment is difficult and aims to halt disease progression and/or hair regrowth if detected and treated early, preventing significant morbidity and anxiety in the patient.
H20 Gin or tonic: the dermatological hazards of cocktail-based quinine
Authors: Lauren Passby
Journal: British Journal of Dermatology (2023)

Abstract Derived from Cinchona tree bark, quinine was first found to be beneficial to health by indigenous Amazonian peoples. Seventeenth-century Jesuit missionaries sent the bark and seeds back to Europe, where word of its therapeutic properties spread. Quinine was promoted as an antiseptic treatment for a range of ailments from the 1600s onward, including septicaemia, erysipelas and scarlet fever. The dermatological risks of quinine quickly became recognized, with Bartholow stating in his 1876 work that ‘The action of quinia has occasionally been attended by the appearance of an eruption on the skin. Sometimes the exanthem has been in the form of an erythema, sometimes it has assumed the appearance of urticaria.’ The pharmacological properties of quinine were exploited by colonial institutions such as the East India Company, who combined a pragmatic approach to antimalarial prophylaxis with a British penchant for aperitivos. The bitter taste of quinine in tonic water led to the addition of water, sugar, lime and gin, giving rise to the gin and tonic (G&amp;T). Its enduring popularity is, in part, due to the astringent nature of quinine and its acidic content that acts as a ‘stomachic tonic; that is, promote appetite, the flow of gastric juice, and the digestive power’. However, since its advent, the G&amp;T has been attributed to many cases of dermatological malaise, as discovered by this systemic review of the published PubMed and SCOPUS literature. To the adage ‘new drugs, new eruptions’, the G&amp;T was no exception. The first published skin reaction to quinine in tonic water dates from 1955, occurring shortly after the patient attended a cocktail party after which they developed ‘a burning sensation in the groins and in his hands and feet’ with progressive oedema and erythema to these areas, spreading to involve nearly all of the body. Other published cases describe (in decreasing frequency) fixed drug eruptions, photosensitive reactions, allergic urticaria and lichenoid drug reactions triggered by quinine in G&amp;Ts. The spectrum of eruptions triggered by tonic water extends to Stevens–Johnson syndrome/toxic epidermal necrolysis triggered by scotch and tonic water consumed at the patient’s peril during a convention in 1972. With an enduring popularity spanning two centuries, and a declaration from Churchill that ‘the gin and tonic has saved more Englishmen's lives, and minds, than all the doctors in the Empire,’ it is vital that dermatologists are aware of the potential dermatological hazards of the G&amp;T.
DS28 In search of salivation? Management of parotid duct injury following Mohs micrographic surgery
Authors: Dalvir Bajwa, William Hunt, Katrina Habaluyas, Sarah Fenwick, Dominic Tabor, Stamatina Verykiou, David Brass, Thomas Oliphant
Journal: British Journal of Dermatology (2023)

Abstract Parotid duct injury is a rare complication of cutaneous surgery usually occurring after excision of deep infiltrating tumours on the cheek. The existing literature is limited to case reports. We present our experience of two cases encountered in our unit over the last 15 years. Our first patient was an 87-year-old man referred for Mohs excision of a biopsy-confirmed morphoeic basal cell carcinoma (BCC) on his right cheek. During tumour extirpation, it was necessary to sacrifice a short section of the parotid duct. This was confirmed by direct visualization of the duct and a visible salivary leak. Immediate referral was made to the plastic surgery department, who also noted ipsilateral weakness in the distribution of the buccal branch of the facial nerve. The parotid duct was repaired over a lacrimal stent secured to his buccal mucosa. The wound was reconstructed with a large rhombic transposition flap and the parotid gland infiltrated with botulinum toxin. Four weeks later, the salivary stent had spontaneously fallen out and fresh-looking saliva was noted emerging from the parotid ampulla. Our second patient was a 65-year-old man referred for Mohs excision of a 3-cm nodular BCC on the left cheek. During tumour extirpation, a short section of the parotid duct was resected, which was clearly visible in the Mohs layer. On this occasion, the patient was referred to colleagues in the maxillofacial surgery department who attended the dermatology surgical unit. Under local anaesthesia, the parotid duct was cannulated using an epidural catheter secured both intraorally and to the residual duct using an absorbable monofilament suture (intraoperative pictures will demonstrate the technique). The Mohs defect was reconstructed with a bilobed transposition flap. Hyoscine patches were supplied to help reduce salivary flow. Marked swelling of the parotid gland developed postoperatively, which settled without further intervention. After 4 weeks, the epidural catheter was removed, and saliva was noted to be flowing from the parotid ampulla. Weakness of the lip elevators was noted in keeping with facial nerve injury. Despite the infrequency of parotid duct injury, it is important that cutaneous surgeons/Mohs surgeons are aware of how to proceed in these cases. In cases where assistance is not available from other specialties, the technique could be undertaken by an appropriately trained dermatological surgeon/Mohs surgeon using local anaesthesia.
P46 A step toward zero leprosy: experiences of Nepal in leprosy data verification
Authors: Rabindra Baskota, Rashmi Baral
Journal: British Journal of Dermatology (2023)

Abstract Records and reports are the sources of data for health programme planning, monitoring and evaluation. Accurate and timely data are crucial to ensure quality leprosy services, including drug supply, complication management and disability prevention. Data verification and validation are the initial steps to achieve the global goal of zero leprosy. The objectives of leprosy data verification were to strengthen the reporting system, to update personal health records and to provide onsite training to leprosy focal persons. Leprosy data verification was conducted in 15 endemic districts of Nepal by a team of national leprosy programme managers, leprosy focal persons, statisticians, dermatologists, paramedic health workers and World Health Organization consultants. The team visited health facilities that provide leprosy services and their corresponding municipalities from August 2021 to December 2021. The team examined the completeness and accuracy of data and information on the patient card, treatment register and monthly reporting form. Data were then compared with the municipal and national database, and edited, cleaned and verified for duplications, and onsite coaching was provided to the leprosy focal persons. Verification of 1210 health records of 15 districts from four provinces was conducted. The number of new leprosy cases was found to be under-reported by 5.5%. Likewise, under-reporting was observed in released-from-treatment cases (19.2% variation) and transfer-out cases (21.4% variation). Over-reporting was observed in re-treatment cases (7% variation), defaulter cases (10.6% variation) and new paediatric cases (38% variation). Common reasons for data variation were error in counting while reporting, error in compiling data from health facilities and a lack of training of focal persons in data recording and reporting. A limitation of the data verification study was that it was conducted in the selected 15 endemic districts and municipalities only. The study suggested that verification, validation and on-site coaching are effective approaches to obtaining quality data on leprosy. Such programmes can be conducted routinely or even during the integrated monitoring and supervision visits of experts from the centre to the local health facilities but should be carried out at the data entry site.
PS01 Prevalence of baseline anxiety and depression in patients attending a tertiary virtual acne service
Authors: Rosie Vincent, Eliza Hutchison, Natalie King, Debbie Shipley
Journal: British Journal of Dermatology (2023)

Abstract Evidence suggests that the prevalence of depression and suicide in those with acne is higher than in the general population. There have also been case reports of suicide in patients taking isotretinoin for acne, although there is a lack of evidence to suggest a true causality. We know that many people with acne and acne scars struggle with impacts on emotions, social/daily activities, study, work and relationships. A prospective cohort study was undertaken, including 150 consecutive new patients in our acne clinics from 7 December 2021 to 5 July 2022 as part of a service evaluation. This project was registered with our local research and innovation team. We captured a snapshot of the demographics of our patients, including baseline Generalised Anxiety Disorder Assessments (GAD-7), Patient Health Questionnaires (PHQ-9) and pre-existing mental health problems. Mean age was 26 years (range 17–46). Sixty-four per cent of patients were women and 36% were men. Thirty per cent of patients reported a previous/current mental health problem, the most common being anxiety (19.3%) and depression (18.0%). The most common medications taken previously or currently were sertraline (4.0%) and propranolol (4.0%). Initial PHQ-9 scores ranged from 0 to 29 points: 49.1% had a score of ≥ 5; 29.1% a score of ≥ 10; and 18.2% a score of ≥ 15. As a comparison, in July–August 2021, the prevalence of depression (classified as a PHQ-8 of ≥ 10) was 32% in women and 20% in men aged 16–29 years in the UK. Rates of depression in our patient cohort were therefore similar to those in the general population in this age group. Interestingly, in the general population, 17% of those aged ≥ 16 years experienced depression during this time. This is significantly higher than the prepandemic prevalence rate of 10%. Initial GAD-7 scores in our cohort ranged from 0 to 21 points: 58.7% had a score of ≥ 5; 30.3% a score of ≥ 10; and 11.0% a score of ≥ 15. As a comparison, in September–October 2021, an estimated 28% of those 16–29 years old experienced moderate–severe anxiety in the UK (GAD-7 equivalent to ≥ 10), and the prevalence was higher in women. Anxiety levels were therefore similar in our cohort compared with the general population. The prevalence of anxiety and depression is high in young adults, which has increased with the COVID-19 pandemic, and the prevalence in our acne cohort is similar to that of the general population of a similar age. It remains that those with moderate–severe acne, regardless of what treatment is received, should be screened and monitored for anxiety and depression.